Hypothermic Oxygenated Perfusion Versus Static Cold Storage for Expanded Criteria Donors in Liver and Kidney Transplantation: Protocol for a Single-Center Randomized Controlled Trial
| Autor: | Matteo Ravaioli, Francesco Vasuri, Maria Cristina Morelli, Valeria Corradetti, Massimo Del Gaudio, Vanessa De Pace, Chiara Zanfi, Antonia D'Errico, Andrea Angeletti, Guido Fallani, Valentina Rosa Bertuzzo, Maurizio Baldassarre, Giorgia Comai, Lorenzo Maroni, Antonio Siniscalchi, Federica Odaldi, Paolo Caraceni, Anna Rossetto, Vito Marco Ranieri, Gabriela Sangiorgi, Gaetano La Manna, Matteo Cescon, Giuliana Germinario |
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| Přispěvatelé: | Ravaioli M., Maroni L., Angeletti A., Fallani G., De Pace V., Germinario G., Odaldi F., Corradetti V., Caraceni P., Baldassarre M., Vasuri F., D'Errico A., Sangiorgi G., Siniscalchi A., Morelli M.C., Rossetto A., Ranieri V.M., Cescon M., Del Gaudio M., Zanfi C., Bertuzzo V., Comai G., La Manna G. |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Cold storage kidney transplantation 030230 surgery Liver transplantation Organ graft Cold Ischemia Time perfusion 03 medical and health sciences 0302 clinical medicine organ transplants Protocol Medicine Kidney transplantation Kidney Machine perfusion clinical trials liver transplantation business.industry temperature General Medicine medicine.disease organ grafts Organ transplant Surgery Clinical trial Transplantation medicine.anatomical_structure randomized 030211 gastroenterology & hepatology business hypothermia |
| Zdroj: | JMIR Research Protocols |
| ISSN: | 1929-0748 |
| Popis: | Background Extended criteria donors (ECD) are widely utilized due to organ shortage, but they may increase the risk of graft dysfunction and poorer outcomes. Hypothermic oxygenated perfusion (HOPE) is a recent organ preservation strategy for marginal kidney and liver grafts, allowing a redirect from anaerobic metabolism to aerobic metabolism under hypothermic conditions and protecting grafts from oxidative species–related damage. These mechanisms may improve graft function and survival. Objective With this study, we will evaluate the benefit of end-ischemic HOPE on ECD grafts for livers and kidneys as compared to static cold storage (SCS). The aim of the study is to demonstrate the ability of HOPE to improve graft function and postoperative outcomes of ECD kidney and liver recipients. Methods This is an open-label, single-center randomized clinical trial with the aim of comparing HOPE with SCS in ECD kidney and liver transplantation. In the study protocol, which has been approved by the ethics committee, 220 patients (110 liver recipients and 110 kidney recipients) will be enrolled. Livers and kidneys assigned to the HOPE group undergo machine perfusion with cold Belzer solution (4-10°C) and continuous oxygenation (partial pressure of oxygen of 500-600 mm Hg). In the control group, livers and kidneys undergoing SCS are steeped in Celsior solution and stored on ice. Using the same perfusion machine for both liver and kidney grafts, organs are perfused from the start of the back-table procedure until implantation, without increasing the cold ischemia time. For each group, we will evaluate clinical outcomes, graft function tests, histologic findings, perfusate, and the number of allocated organs. Publication of the results is expected to begin in 2021. Results Dynamic preservation methods for organs from high-risk donors should improve graft dysfunction after transplantation. To date, we have recruited 108 participants. The study is ongoing, and recruitment of participants will continue until January 2020. Conclusions The proposed preservation method should improve ECD graft function and consequently the postoperative patient outcomes. Trial Registration ClinicalTrials.gov NCT03837197; https://clinicaltrials.gov/ct2/show/NCT03837197 ; Archived by WebCite® at http://www.webcitation.org/76fSutT3R International Registered Report Identifier (IRRID) DERR1-10.2196/13922 |
| Databáze: | OpenAIRE |
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